How is your regional month structured at your program?

[MDF1]

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Hi, I am a little miffed about the number of PNB's ive done during my regional month so far at my program...4 in 10 days. We have plenty of ortho at our place and there are many blocks to be done on a given day, only problem is you are assigned to a room and do only the blocks for that room that day. I think eventually I will have plenty of numbers to meet minimum req's but I feel like if the regional person just stayed in preop and did all the blocks, the numbers would go up, for everyone at that. I know that raises other potential problems with staffing, etc, but I was wondering if ppl could post how the regional rotation is done at various programs because id like to bring some ideas to my program director and the regional attendings.

I guess if you can post specifics like the major responsibilities of the regional resident, if they are also giving breaks, or not, rounding on the pts w/ blocks or the pain service as well, if there is a regional attending for the day, as the regional resident do you also take any neuraxial blocks as well for other operations, etc. Thanks to all in advance.

 

[psychbender]

Intern here, some of the finer details may be a bit off. We have a dedicated regional room with four beds, and dedicated regional staff. All blocks are performed by the regional resident/fellow/staff, who also round on pts who received epidurals/spinals in the OR by the primary anesthesiologist. I recall one of the residents here also saying that we spend a month in Germany doing blocks on wounded soldiers before sending them stateside (I'm in an Army residency program).

 

[bogatyr]

We have a dedicated regional resident and a dedicated regional staff. No fellows. The regional resident does all the blocks that day. We have a separate resident on the acute pain service who rounds on all the catheters that the regional resident puts in plus the epidurals. We have dedicated block rooms near the PACU. If it is a light ortho day, the residents are aggressive about blocking vascular, breast, hernia patients, etc. If there's not even any of that going on they may place epidurals to help speed room turnover time. The resident has no other responsibilities other than doing post-op checks on all his blocks, including calling outpatients at home. I would say most residents get close to 100 blocks during each regional month (each resident gets 2 - 3 months).

 

[Bertelman]

Hi, I am a little miffed about the number of PNB's ive done during my regional month so far at my program...4 in 10 days. We have plenty of ortho at our place and there are many blocks to be done on a given day, only problem is you are assigned to a room and do only the blocks for that room that day. I think eventually I will have plenty of numbers to meet minimum req's but I feel like if the regional person just stayed in preop and did all the blocks, the numbers would go up, for everyone at that. I know that raises other potential problems with staffing, etc, but I was wondering if ppl could post how the regional rotation is done at various programs because id like to bring some ideas to my program director and the regional attendings.

I guess if you can post specifics like the major responsibilities of the regional resident, if they are also giving breaks, or not, rounding on the pts w/ blocks or the pain service as well, if there is a regional attending for the day, as the regional resident do you also take any neuraxial blocks as well for other operations, etc. Thanks to all in advance.

If the regional resident isn't placing the blocks for the ortho cases, who does?

Like others have stated, we've got a dedicated resident that does all blocks, and only blocks.

 

[MDF1]

the regional resident does ortho blocks, but only for the room he/she is assigned to, ie 2-4 blocks max/day, and sometimes only one/day if thats all thats in that room. There are multiple ortho rooms and those other blocks are done by whatever random resident was assigned to that room or an attending if they have no resident, so lots of blocks missed by the regional resident per day, im on track for 20 blocks this month if im lucky... i would say 30-40/month would be possible if we were doing all blocks for each day.

Thanks for the replys keep em coming.

 

[Bertelman]

the regional resident does ortho blocks, but only for the room he/she is assigned to, ie 2-4 blocks max/day, and sometimes only one/day if thats all thats in that room. There are multiple ortho rooms and those other blocks are done by whatever random resident was assigned to that room or an attending if they have no resident, so lots of blocks missed by the regional resident per day, im on track for 20 blocks this month if im lucky... i would say 30-40/month would be possible if we were doing all blocks for each day.

Thanks for the replys keep em coming.

At least you can count on getting blocks on non-reg months.

 

[pgg]

We had a dedicated resident for regional each month, sometimes with an SRNA along too. That resident had priority on ALL blocks and wasn't obligated to share with the regional SRNA, although we usually did because there were plenty to go around, especially 1st case of the day when several people needed blocks done simultaneously.

The only exception was if the staff anesthesiologist or CRNA* for the case wanted to do the block personally, they could. They were not supposed to steal the block for their resident or SRNA ... though in reality I had a few run-ins with CRNAs trying to steal blocks from me to give to their SRNAs.

I did a lot of blocks during my regional months, and quite a few more on days when the regional team was too busy doing blocks to take care of my patients.


* Military program, so the CRNAs practice independently and teach SRNAs; they get attending-like deference for the most part.

 

[TrustMe]

Haven't done my regional month yet, but we have a resident dedicated to regional each month. They get priority on any and all blocks, epidurals, spinals, etc. From what I understand we have enough that often attendings will have to do their own because the block resident is too busy to cover everyone. I am told that they get around 200 blocks for the month on average. The block resident is also responsible for rounding on all in-house post-op pt's with catheters or epidurals. There is an acute pain attending each day that staff's all of the post-op pt's.

 

[MDF1]

At least you can count on getting blocks on non-reg months.

Well ya but thats pretty few and far between, basically luck of the draw.

 

[MDF1]

Pretty sh*tty to be doing cases on your regional month, at the expense of more blocks.

Pretty much the way i see it, plus theres other drawbacks like time pressure to get the block in between cases/or having to find some unlucky soul to break you out to do the block for your room/or losing the block to some passer by resident.

Today was a nice example, 2 blocks for me out of 7 total done today

Thanks again everyone, sounds pretty standard to have the regional resident out of the OR to do blocks for the month. Im sure if we adopted that system, individual residents would gain in numbers.

 

[proman]

Our regional month is pretty worthless. CA1s see it on their schedules as the 3rd or so month and get excited. In actuality it's a you'll-do-regional-if-we-remember-but-will-be-doing-mostly-washouts-and-cranis. Here's our setup, which would work just as well without that month:

All residents get to do the first X procedure of the day in their rooms. Whether it's a block or catheter or epidural etc. The additional procedures for their room are done by another resident. This resident is normally the PACU resident (CA3 mostly). Exception is our outpatient center where you do all the blocks in the room.
As PACU resident you do blocks/epidurals in the AM, and run the PACU in the PM. This works out quite well. We also have an acute pain service with 2 residents who help out with extra blocks if needed. The benefit is all this gets done while the rooms are running so there's no delay in getting the blocks in place. One day on my PACU rotation I did 3 interscalene catheters and 7 single shots. I wish we had a dedicated block area, it's a major pain using prep area +/- PACU and a major slow-down.

We also get to go to HSS for a block month, which gets rave reviews, and have another month at 1 of 2 community hospital (all as CA3) that do a lot of joints and hand/foot/ankle stuff. Our experience is clearly back loaded but we end up with plenty of thoracic epidurals, single shot (mostly US guided) and PNCs (again US guided). Our regional month is really a misnomer but our biggest obstacle is getting the orthopods to agree to it. They wave their hands mumble something about compartment syndrome and run away.